A physiological approach to the interpretation of cardiotocography

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Abstract

In recent decades, the number of cesarean section (CS) deliveries has increased significantly worldwide. In Russia, the CS rate rose from 17.9% in 2005 to 30.3% in 2020. One of the main indications for CS is fetal distress, which requires careful monitoring of its condition. Improper or untimely interventions during childbirth can lead to complications for the mother and fetus, including irreversible damage to the central nervous system. Cardiotocography (CTG) remains the main method for monitoring fetal health, but there is often controversy among doctors about how to interpret the data. Various national and international guidelines have been developed to standardize the assessment of fetal heart rate and systematize the types of CTG. However, categorizing fetuses does not provide a personalized approach to evaluating their condition. Currently, more attention is paid to the physiological approach to CTG interpretation. This approach takes into account not only heart rate parameters, but also the adaptive capabilities of the fetus, the type of intrauterine hypoxia, the duration of pregnancy, and the individual functional reserves of the fetus under specific conditions. This method allows for a more personalized assessment of the fetal condition, which helps to make informed decisions about future delivery strategies. The introduction of a physiological approach to CTG interpretation makes it possible to reduce the frequency of neonatal hospitalizations in intensive care units, as well as to reduce the proportion of surgical deliveries.

Conclusion: The physiological approach to CTG assessment, training of medical personnel and continuous monitoring of fetal condition make it possible to optimize the management of labor, reduce the risk of complications and improve outcomes for newborns.

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About the authors

M. А. Ponimanskaya

L.A. Vorokhobov City Clinical Hospital No. 67, Moscow City Healthcare Department

Author for correspondence.
Email: ponimanskaya@mail.ru
ORCID iD: 0000-0001-9447-110X

PhD, Deputy Chief Physician for Obstetric and Gynecological Care

Russian Federation, Moscow

P. A. Kuznetsov

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: poohsmith@mail.ru
ORCID iD: 0000-0003-2492-3910

PhD, Associate Professor, Department of Obstetrics and Gynecology

Russian Federation, Moscow

Yu. Е. Dobrokhotova

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: Pr.Dobrohotova@mail.ru
ORCID iD: 0000-0002-7830-2290

Dr. Med. Sci., Professor, Honored Doctor of the Russian Federation, Head of the Department of Obstetrics and Gynecology

Russian Federation, Moscow

L. V. Bragina

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: dr.bragina@mail.ru
ORCID iD: 0009-0003-2908-6928

PhD student, Department of Obstetrics and Gynecology, Institute of Surgery

Russian Federation, Moscow

O. N. Lee

L.A. Vorokhobov City Clinical Hospital No. 67, Moscow City Healthcare Department

Email: Li-doctor@mail.ru
ORCID iD: 0000-0002-7770-2751

PhD, Deputy Chief Physician for the Medical Department of the Perinatal Center

Russian Federation, Moscow

S. Z. Sanaya

L.A. Vorokhobov City Clinical Hospital No. 67, Moscow City Healthcare Department

Email: sevastina@mail.ru
ORCID iD: 0000-0001-8289-3380

obstetrician-gynecologist

Russian Federation, Moscow

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2. Fig. 1. The proportion of newborns hospitalized in the NICU (%) in a second-level hospital

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3. Fig. 2. Percentage of cesarean sections by quarter from the beginning of 2022 to the first quarter of 2024.

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